Screening mammography is recommended every year for women beginning at age 40. If you have an increased risk due to a family history of breast cancer, you should ask your doctor if you should begin screening before age 40.
Before scheduling a mammogram, inform your doctor about any new problems or symptoms you may be experiencing. You should also let them know about any prior surgeries, hormone use, family history of breast cancer or any new drugs, or diets you are on. Let your doctor know if there is any possibility you are pregnant.
The best time to schedule your mammogram is one week AFTER your period ends. Do not schedule your mammogram for the week before your period if your breasts are usually tender during this time.
When making your appointment, inform your scheduler if you have breast implants as testing will take slightly longer to perform.
Day of the Exam
Although the screening procedure itself will only take 15-20 minutes, you should allot yourself enough time to arrive early, fill out paperwork, consult with the mammography technologist and the time it takes to undress and redress for the exam. This is usually a little more than one hour.
Do not wear deodorant, talcum powder or lotion on your chest or arms. These products interfere with the test and may appear as calcium deposits on the x-ray film.
Inform the tester if you are experiencing any pain or tenderness in your breast prior to the exam.
Bring any previous mammograms you have taken and be prepared to make them available to the radiologist during the exam. Due to the variety appearance of breast tissue, prior exams will help your radiologist interpret your results and identify any subtle changes that could be caused by cancer.
Please do not bring small children on the day of your examination. Children are not allowed in the mammography suite and may not be left unattended.
Before the Exam Begins
You should arrive 15 – 20 minutes before your scheduled appointment time. You will be asked to remove all jewelry and clothing above the waist and you will be given a gown that opens in the front. The mammography technologist will engage you in a brief interview about your family history and general health.
You will then have a visual and manual exam in which the mammography technologist will perform a physical examination of your breasts for the presence of masses or skin abnormalities.
Steps of the Mammogram Procedure
During mammography the technologist will position you to image your breast. Your breast will be placed on a special cassette and compressed gradually with a paddle made of clear, soft plastic. If compression is painful, let the technologist know, and less compression will be used. Recognize, however that adequate breast compression is essential to a good examination.
Breast compression is necessary to do the following:
- Even out the breast thickness so that all of the tissue can be visualized
- Spread out the tissue so that small abnormalities won’t be obscured by overlying breast tissue
- Allow the use of a lower X-ray dose since a thinner amount of breast tissue is being imaged
- Hold the breast still in order to eliminate blurring of the image caused by motion
- Reduce X-ray scatter which also leads to poor image quality
The technologist will go behind a glass shield while making the X-ray exposure, which will send a beam of X-rays through the breast to the film behind the plate, thus exposing the film. After each picture is taken, you will be positioned for the next view. The routine views are a top-to-bottom view and a side view of each breast for a total of four views. If you have exceptionally large breasts, additional views may be required to make sure that all of the breast tissue is imaged.
If you have breast implants, four views of each breast will be obtained. The examination process should take about half an hour (one hour for patients with implants). When the mammogram is completed the technologist will develop the films and assess their technical quality while you wait. Occasionally, more images may be taken at this point.
After the Test
The radiologist, who is a physician experienced in mammography and other X-ray examinations, will analyze the images, describe any abnormalities, and suggest a likely diagnosis. The report will be dictated by the radiologist, and then sent to your referring physician.
False Positives and Repeat Procedures
Between 5% and 10% of mammogram results are indeterminate, resulting in the need for additional mammogram views or breast ultrasound. If these follow-up tests confirm that no cancer was present, which is most of the time, the initial examination is said to have been falsely positive.
It is estimated that a woman who has yearly mammograms between ages 40 and 49 has about a 30% chance of having a false-positive mammogram at some point in that decade, and about a 7% to 8% chance of having a breast biopsy within the 10-year period. The estimate for false-positive mammograms is about 25% for women ages 50 or older.